Santa Clara County supervisors approve study on youth psych beds

Inpatient psychiatric unit would be the first in the county in more than two decades

Santa Clara County has not had an acute-care, inpatient psychiatric unit for youth for more than 20 years, but the Board of Supervisors voted unanimously on Tuesday, June 9, to support a feasibility study for an inpatient unit for children and adolescents.

Youth with psychiatric issues are typically hospitalized locally for 72 hours on a "5150" psychiatric hold. But children under the age of 18 in need of longer-term inpatient treatment are sent to hospitals in Fremont, Vallejo, Concord and Sacramento, said Supervisor Joe Simitian, who introduced the action.

The locations put mentally fragile young people far from their families and place a hardship on parents and families, he said.

The need is great across all economic and demographic groups, Simitian said. In an eight-month period, hospital staff made more than 600 referrals for psychiatric beds out of the area. Of those, more than 400 were unduplicated referrals of Santa Clara County children and teens, according to county records, Simitian said.

But those figures are only for youth who are uninsured or on MediCal, he said.

"This doesn't include private pay or those with commercial insurance. I can't even speculate what that number would be," Simitian said.

The lack of beds for youth represents a significant problem, Simitian said.

"It's better therapeutically for kids to be close to their community, and their own local mental health providers, when they're in crisis," he said. "... I'm worried that having treatment options so far away deters kids and families from seeking the help they need.

"We know that these beds are an integral and essential part of the continuum of care. The next step is to figure out how to get the best possible help for these kids closer to home."

Santa Clara County is one of the largest urban counties in the state, yet there are more than 20 kids on any given day who are sent out of the county to seek treatment, he said.

Sarah Gentile, a Los Altos parent, said she has two children with medical needs. Her daughter has a serious and rare neuromuscular disease and her son has suffered from depression.

Doctors like rarity, she said, so her daughter has been seen by numerous heads of medical departments at local facilities. But when her son had a major depressive episode and needed to be hospitalized while undergoing a new medical treatment, Gentile got a rude awakening.

At the El Camino Hospital emergency room, the psychiatrist had to call around to see which facility could take her son, she said. Gentile, who initially did not understand the situation, wanted her son sent to Stanford, but then she learned that there were no beds in the county at all.

"I can't imagine leaving my child alone," she said, tearfully. "Even after a $2 billion expansion at Stanford, there are zero beds for kids."

Administrative staff will develop a report within six months, which will explore possible ways to create and fund the inpatient unit, including using existing county facilities, contracting out services, and having a flexible unit that could accommodate adults during low-peak times.

An inpatient unit would create a broader acute-care system for youth in the county, said Toni Tullys, director of the county's Behavioral Health Services Administration.

Supervisor Ken Yeager asked staff to look into potential collaborations with insurance companies and private health plans for how services would be covered.

Simitian and Yeager said the report should consider the demographic profile of youth needing the inpatient services, including their ages, ethnicity and geographical location.

Simitian also advised staff to not forget about insured or private-pay patients in addition to those without insurance or on MediCal, he added.

"Each one of those is a kid (in need)," he said.

Related content:

Simitian: 'Significant' need for inpatient psych beds for teens

Why so few hospital beds for teens?

When a teen is in mental health crisis, what's working -- and what isn't

Breaking the silence: How youth, adults overcame cultural stigmas against depression and got help

Storify: Palo Alto community urges support for teen wellbeing

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28 people like this
Posted by Sarah1000
a resident of Los Altos
on Jun 9, 2015 at 9:17 pm

Thank you for your coverage of the lack of adolescent mental health services in our community. I just want to clarify one point. A child or adolescent who needs inpatient psychiatric care of ANY length cannot receive it in Santa Clara County because there are no inpatient adolescent psychiatric beds at any hospital in SCC. There is no local hospitalization option for youth who are placed on 5150 holds. If they are seen in the emergency department of a SCC hospital and placed on a 5150 hold, they are "held" in the ED while the hospital tries to find an out-of-county hospital which will agree to treat the child. The child is, then, transported by ambulance (at the financial obligation of the child's family) to the treating hospital.
Also, I said today (at the SCC Board of Supervisors' meeting) that I could not imagine being a mother who had to leave her child alone at the adult psychiatric unit at Valley Med (where some youth have been taken after being placed on 5150 holds by the police). I was grateful that I was able to leave my son at Mills Peninsula in San Mateo because they could keep him safe during a change in his medication when I could not.
I am so very grateful to Supervisor Simitian and the entire Board for taking this fist step in improving child and adolescent mental healthcare in Santa Clara County.

9 people like this
Posted by Cubberley neighbor
a resident of Greenmeadow
on Jun 10, 2015 at 9:01 am

The experience of many of our fellow parents have had to drive or fly their teen in crisis out the Bay Area for adequate therapy and treatment.
Many of us have had a code word for being at the breaking point and a subsequent "evacuation" plan.
You do what you have to do. After twenty years,
I could not be more unimpressed with this community.

15 people like this
Posted by Bette H
a resident of Los Altos
on Jun 10, 2015 at 9:46 am

Thank you to Sarah and her family for showing up for others on this awful and sad situation. It's shocking that our community doesn't currently provide these basic services for its most vulnerable members and that many people only become aware of it when they're in a crisis situation.

Thanks to Supervisor Simitian and the board for taking this step to address the problem.

17 people like this
Posted by Not a Billionaire
a resident of Palo Alto High School
on Jun 10, 2015 at 11:58 am

I am ashamed of Palo Alto, but really disgusted with the overpriced Stanford Hospital and Licille Packard Children's Hospital. They spend BILLIONS on expansions, but still fail to serve our community, claiming that psyche beds for teens is too costly, not a good business model, etc.

Yeah, right, lame excuses as usual! Truth is, all that $$$$$$$$ from overcharging the public could be put to better use. I don't know how the hospital administrators sleep at night.

7 people like this
Posted by resources
a resident of Palo Alto High School
on Jun 10, 2015 at 7:41 pm

Very worthwhile to do this study. It would be nice to have this resource closer if it is feasible. At 400 pediatric referrals per 8 months, and an average stay of about a week (Web Link, though some hospitals have much lower or higher average lengths of stay), that works out to an average census of 12 kids at a time. If they think that's enough to build an inpatient program around, with all of the facilities and resources suitable for such a population, then great. It would be a small unit, though, perhaps divided into even smaller sub-units for younger kids, teen girls, and teen boys, at an age where peer interactions are a large part of treatment. The study may well find that it's better to focus on local intensive day programs and on bolstering existing regional inpatient units.

8 people like this
Posted by Sarah1000
a resident of Los Altos
on Jun 10, 2015 at 10:53 pm

Resources: if you read the article again, you will see that it says 600 referrals in eight months. 200 of those referrals were for kids who had two hospitalizations in that eight months. And those numbers don't include any kids, like my son, whose stay was covered by private insurance. The MVLA high school district alone had 75 students who were actively monitored for being suicidal during this past school year. If you extend these numbers out to include all the affluent communities in our county (Palo Alto, Los Altos, Saratoga, Cupertino, Los Gatos etc.), the number of hospitalized children and adolescents must be well over 1,000.
(Just FYI-Mills houses boys and girls in the same unit but in separate rooms.)
And, just as there are no inpatient adolescent psych beds- for kids with private insurance, there are no partial hospitalization programs in Santa Clara County. (EMQ FamiliesFirst has a continuum of adolescent mental health services but they are only available to kids on Medi-Cal. Only EMQ's Crisis Stabilization Services are offered to all children and adolescents. These stabilization services last for just 23 hrs and 59 minutes and are designed to either get the child back out into the community with "wraparound" support services or get the child into an out-of-county inpatient unit.) We need our hospitals to come forward and provide our community with the inpatient and outpatient services that our children so desperately need. (Other institutions such as Johns Hopkins and Mayo Clinic offer comprehensive mental health programs for all ages.)

2 people like this
Posted by Susan
a resident of Los Altos
on Jun 11, 2015 at 9:42 am

Thank you, Supervisor Simitian, for leading the charge to provide necessary healthcare for ALL of the children in Santa Clara county. It is inexcusable that there are NO inpatient beds for these children - because of their mental health diagnosis. I applaud you for examining such an important issue!

Like this comment
Posted by resources
a resident of Palo Alto High School
on Jun 11, 2015 at 8:03 pm

Sarah1000, thanks for pointing out that the figure was for Medi-Cal and uninsured only -- I must have skimmed over it. Re-reading the article, I'm still interpreting "hospital staff made 600 referrals for psychiatric beds out of the area" and "Of those, more than 400 were unduplicated referrals of Santa Clara County children and teens" to mean that 200 were for adult psychiatric beds, rather than that 200 were repeat pediatric hospitalizations. I see now that it's ambiguous. In any case, I'm glad they are doing this feasibility study, and hope they come to the correct conclusion, whatever that may be. I'm sorry to hear what your family has gone through.

Like this comment
Posted by Sarah1000
a resident of Los Altos
on Jun 12, 2015 at 6:40 am

Thanks Resources: My son is now 18 but I think having adequate resources for our kids should be our top priority. My heart breaks for the kids who have died by suicide. Thanks for caring enough to follow this issue and comment.

2 people like this
Posted by neighbor
a resident of Greenmeadow
on Jun 12, 2015 at 12:13 pm

The need for inpatient mental health treatment for children and adolescents is long-standing, but a key culprit has not been mentioned -- the insurance companies. Their reimbursement rates for inpatient psychiatry vs. inpatient medical patients can differ greatly, with reimbursement for necessary services so low that it is impossible to operate psychiatry units in the black. Additionally, treatment of the young is always more labor-intensive than that required by adults, which translates into higher costs. That's why so many closed up shop years ago. I'm so pleased that Joe Simitian is, once again, taking a leadership role in advocating for our community needs. I hope something can be done.

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